The effect of flap advancement on bone graft displacement with or without membrane stabilization – a preclinical study
Abstract Background Displacement of bone graft materials following horizontal bone augmentation (HBA) procedures may compromise treatment outcomes, yet the role of flap tension remains unclear. This study aims to assess the effect of varying degrees of flap advancement (FA) and associated flap tensi...
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BMC
2025-08-01
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| Series: | BMC Oral Health |
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| Online Access: | https://doi.org/10.1186/s12903-025-06692-x |
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| author | Wenjie Zhou Emilio Couso-Queiruga Emilio A. Cafferata Ausra Ramanauskaite Frank Schwarz Clemens Raabe |
| author_facet | Wenjie Zhou Emilio Couso-Queiruga Emilio A. Cafferata Ausra Ramanauskaite Frank Schwarz Clemens Raabe |
| author_sort | Wenjie Zhou |
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| description | Abstract Background Displacement of bone graft materials following horizontal bone augmentation (HBA) procedures may compromise treatment outcomes, yet the role of flap tension remains unclear. This study aims to assess the effect of varying degrees of flap advancement (FA) and associated flap tension on graft displacement during HBA, as well as the influence of membrane stabilization and soft tissue characteristics. Methods HBA was performed at the bone concavity of the diastema region in pig hemimandibles, corresponding to uncontained defect morphologies. Full-thickness mucoperiosteal flaps were coronally advanced using a single periosteal releasing incision (moderate FA1) or additional scoring (major FA2). Sites were randomized for membrane fixation with two pins or no fixation. Changes in graft material thickness (ΔGMT) were assessed at nine reference levels (L0–L8) before and after wound closure via CBCT. Linear regression models were applied to correlate ΔGMT with the FA, fixation and soft tissue phenotypical characteristics. Results Sixty surgical procedures were categorized into four groups (FA1 - Pins, FA1 + Pins, FA2 - Pins, FA2 + Pins). FA2 achieved greater advancement (9.20 ± 0.55 mm) with lower tension (0.02 ± 0.01 N) than FA1 (4.42 ± 0.67 mm; 0.09 ± 0.02 N). Reduced graft displacement was observed at L0 with a mean ΔGMT of -35.66 ± 30.68% for FA2 versus − 44.99 ± 20.80% for FA1 (p < 0.001). Membrane stabilization did not significantly influence the overall ΔGMTs. Regression analysis revealed a significant correlation between FA and ΔGMT (p = 0.01), independent of the fixation method (p = 0.56), and soft tissue phenotypical characteristics (p > 0.06). Conclusions Greater flap advancement and reduced tension improve graft stability during HBA, while membrane fixation with two pins is insufficient to ensure graft stability in challenging, uncontained defect morphologies. |
| format | Article |
| id | doaj-art-b407dfef770343a2b5d7be297efe16e2 |
| institution | Kabale University |
| issn | 1472-6831 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Oral Health |
| spelling | doaj-art-b407dfef770343a2b5d7be297efe16e22025-08-20T03:46:16ZengBMCBMC Oral Health1472-68312025-08-0125111010.1186/s12903-025-06692-xThe effect of flap advancement on bone graft displacement with or without membrane stabilization – a preclinical studyWenjie Zhou0Emilio Couso-Queiruga1Emilio A. Cafferata2Ausra Ramanauskaite3Frank Schwarz4Clemens Raabe5Department of Oral Surgery and Implantology, Goethe UniversityDepartment of Oral Surgery and Stomatology, School of Dental Medicine, University of BernDepartment of Oral Surgery and Implantology, Goethe UniversityDepartment of Oral Surgery and Implantology, Goethe UniversityDepartment of Oral Surgery and Implantology, Goethe UniversityDepartment of Oral Surgery and Implantology, Goethe UniversityAbstract Background Displacement of bone graft materials following horizontal bone augmentation (HBA) procedures may compromise treatment outcomes, yet the role of flap tension remains unclear. This study aims to assess the effect of varying degrees of flap advancement (FA) and associated flap tension on graft displacement during HBA, as well as the influence of membrane stabilization and soft tissue characteristics. Methods HBA was performed at the bone concavity of the diastema region in pig hemimandibles, corresponding to uncontained defect morphologies. Full-thickness mucoperiosteal flaps were coronally advanced using a single periosteal releasing incision (moderate FA1) or additional scoring (major FA2). Sites were randomized for membrane fixation with two pins or no fixation. Changes in graft material thickness (ΔGMT) were assessed at nine reference levels (L0–L8) before and after wound closure via CBCT. Linear regression models were applied to correlate ΔGMT with the FA, fixation and soft tissue phenotypical characteristics. Results Sixty surgical procedures were categorized into four groups (FA1 - Pins, FA1 + Pins, FA2 - Pins, FA2 + Pins). FA2 achieved greater advancement (9.20 ± 0.55 mm) with lower tension (0.02 ± 0.01 N) than FA1 (4.42 ± 0.67 mm; 0.09 ± 0.02 N). Reduced graft displacement was observed at L0 with a mean ΔGMT of -35.66 ± 30.68% for FA2 versus − 44.99 ± 20.80% for FA1 (p < 0.001). Membrane stabilization did not significantly influence the overall ΔGMTs. Regression analysis revealed a significant correlation between FA and ΔGMT (p = 0.01), independent of the fixation method (p = 0.56), and soft tissue phenotypical characteristics (p > 0.06). Conclusions Greater flap advancement and reduced tension improve graft stability during HBA, while membrane fixation with two pins is insufficient to ensure graft stability in challenging, uncontained defect morphologies.https://doi.org/10.1186/s12903-025-06692-xAlveolar ridge augmentationCone-beam computed tomographyDental implantsGuided bone regenerationSurgical flapsBone substitutes |
| spellingShingle | Wenjie Zhou Emilio Couso-Queiruga Emilio A. Cafferata Ausra Ramanauskaite Frank Schwarz Clemens Raabe The effect of flap advancement on bone graft displacement with or without membrane stabilization – a preclinical study BMC Oral Health Alveolar ridge augmentation Cone-beam computed tomography Dental implants Guided bone regeneration Surgical flaps Bone substitutes |
| title | The effect of flap advancement on bone graft displacement with or without membrane stabilization – a preclinical study |
| title_full | The effect of flap advancement on bone graft displacement with or without membrane stabilization – a preclinical study |
| title_fullStr | The effect of flap advancement on bone graft displacement with or without membrane stabilization – a preclinical study |
| title_full_unstemmed | The effect of flap advancement on bone graft displacement with or without membrane stabilization – a preclinical study |
| title_short | The effect of flap advancement on bone graft displacement with or without membrane stabilization – a preclinical study |
| title_sort | effect of flap advancement on bone graft displacement with or without membrane stabilization a preclinical study |
| topic | Alveolar ridge augmentation Cone-beam computed tomography Dental implants Guided bone regeneration Surgical flaps Bone substitutes |
| url | https://doi.org/10.1186/s12903-025-06692-x |
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